To help make sure Blue Cross Blue Shield of Michigan and Blue Care Network members receive the most appropriate and cost-effective therapy, we require providers to take additional steps before certain drugs are eligible for reimbursement.
Prior authorization requirements
We require providers to request prior authorization for certain medicines, such as specialty drugs, to ensure certain clinical criteria are met.
Submitting prior authorization requests
For drugs that require prior authorization, providers should submit requests as follows:
- For pharmacy benefit drugs, submit requests through CoverMyMeds. Learn about submitting requests electronically and through other methods on Blue Cross Pharmacy Benefit Drugs or on BCN Pharmacy Benefit Drugs.
- For most medical benefit drugs, including CAR-T cell therapy drugs, submit requests through NovoLogix ® . Learn about submitting requests through NovoLogix and through other methods on Blue Cross Medical Benefit Drugs or on BCN Medical Benefit Drugs.
- For oncology and supportive care medical benefits drugs, submit requests to Carelon Medical Benefits Management (formerly known as AIM Specialty Health ® ). Learn about submitting requests to Carelon electronically and through other methods on Blue Cross Medical Benefit Drugs or on BCN Medical Benefit Drugs.
Step therapy requirements
Step therapy requires that the member has tried an alternative therapy first, or that the prescriber has clinically documented why the member cannot take the alternative therapy. In some cases, step therapy requirements may require members to first try over-the-counter products.
